Linezolid Intravenous for Adults

Who can administer

May be administered by registered competent doctor or nurse/midwife

Important information

• See monitoring requirements
• Consider intravenous to oral switch as soon as possible as excellent oral bioavailability (approx.100%) - use same dose orally as intravenously
• Red-light antimicrobial: requires pre-authorisation by Microbiology or ID prior to use 24 hours / 7 days a week
• There are numerous important interactions - check current BNF (and also see under 'Monitoring')

Available preparations

Linezolid 600mg per 300ml solution for infusion

Reconstitution

Already in solution

Infusion fluids

Not required - product ready for infusion

Methods of intravenous administration

Intermittent intravenous infusion

• Administer over 30 to 120 minutes

Dose in adults

Usual dose

• Give 600mg every twelve hours
• Duration of treatment: usually 10 to 14 days

Renal impairment

• eGFR less than 30ml/minute/1.73m2 - no dose adjustment required but use with caution as metabolites may accumulate
• Monitor FBC closely if eGFR <10ml/minute/1.73m2 (ref 1)
• If being used in patients on haemodialysis- should be given after dialysis session

Hepatic impairment

• No dose adjustment is required. However, there are limited clinical data and it is recommended that linezolid should be used in such patients only when the anticipated benefit is considered to outweigh the theoretical risk

Monitoring

• Monitor FBC (including haemoglobin, platelets, and total and differential leucocyte counts) weekly in all patients (risk of haematopoeitic disorders)
• Monitor blood pressure closely in uncontrolled hypertension, phaeochromocytoma, carcinoid, thyrotoxicosis, bipolar depression, schizoaffective disorder, acute confusional state or in patients taking SSRIs, tricyclic antidepressants, triptans, sympathomimetic agents, vasopressive agents, dopaminergic agents, pethidine or buspirone
• Monitor for signs and symptoms of serotonin syndrome if used with serotonergic agents
• Monitor for signs of metabolic acidosis

Further information

• Linezolid should not be used in patients taking any drug which inhibits Monoamine oxidases A or B (e.g. phenelzine, selegiline, moclobemide, isocarboxazid) or within two weeks of having taken such drugs
• The safety and efficacy of linezolid when administered for periods longer than 28 days have not been established. Severe peripheral or optic neuropathy may occur rarely, especially if linezolid is used for longer than 28 days
• High-tech prescription needed if patient being discharged on oral form

Storage

Store below 25⁰C

References

Fresesius Kabi SPC July 2018

Zyvox SPC May 2021

(1) Antimicrobial Guidelines for GUH

Therapeutic classification

Oxazolidinone antimicrobial